Patients still wanting a lot of treaments

Specialties Hospice

Published

I'm a new hospice nurse, and I'm finding a lot more patients than what I had anticipated are wanting a lot of treatment for things unrelated to their hospice diagnosis. Or wanting ct scans, pet scans to r/o symptoms. A lot of people being discharged for 911ing to the hospital. I'm doing my best to educate families, is this the norm or am I just not good at this??

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How many is a lot? If you have a census-driven management team they will admit people who clearly aren't ready.

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We almost always let patients have treatments and office visits for non-terminal diagnosis related items. We don't d/c for ER visits or those rare hospital/clinic peritoneal taps for instance. It's a must to d/c upon hospital admission though. It's difficult to argue for a hospice agency to cover CT scans etc but sometimes they have to. In those cases our agency makes hospital/clinic contracts with special discounted rates - it's easier to do before the procedure.

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Yeah we get ALOT too :•\ Our problem kinda goes like this... Management puts pressure on marketing and admissions to 'find something' (census driven). They make alot of promises to get people to sign up (physical therapy/rehab provided is a common one, then when we try to get an order its 'no') even if they dont completely understand or are not completely on board with hospice. I even get pts that are full code! How is one accepting of end of life and want hospice care, but they want CPR? Next the RNCM shows up and is the bad guy for breaking down the real deal. Palliative care, comfort measures only, no more diagnostics/aggresive treatment, no more 911/hospital stays, call us to manage sx, edu on disease process and expected decline, lets reduce this huge med/vitamin list, etc. Then the revocations come (or discharges for those who were not approprate to begin with). Then the RNCM gets it for not keeping the pt on/preventing ER visits, even though the pt/family were not fully understanding or accepting to begin with. *sigh* Please dont get me wrong, I do love making a difference and being able to help maximize quality of life at an extremely difficult time. I feel like I dont get to do enough of that because of all the other €r^p.

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I feel like it's more, they don't want to continue to see their own doc, they just want us to treat all other conditions, usually because they aren't ambulatory. It's easy to keep within the mindset of " only treating and managing the hospice diagnosis" but it's hard when your out there a few times a week and it keeps being insisted on by the family. Just not what I thought I guess.

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Specializes in Addictions, Psych, Critical Care, Hospic.

You're question is a good one as it tells you a couple of things. The first being a lack in education or perhaps an unwillingness to conduct a proper screening at the first client contact. Hospice Eligibility is not only about determining if someone meets criteria but also finding out if hospice is the right service at the time for that person. When the screening and admission process does not take into consideration what a patient/family member really expects from hospice and why are they looking now as opposed to some previous time misunderstandings occur. It often ends up being a confusing, unsatisfactory experience for everyone. These are the cases that end up with misappropriated complaints being submitted to administration about nursing because everyone is unhappy.

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I have found in all of my years of hospice experience that discussing the family/pts agenda is crucial. Sometimes people are very appropriate for hospice services but they are not ready to live with the hospice philosophy , and that's OK. They should then be referred for a palliative consult instead. Contrary to popular belief you MAY be a full code and be on hospice services. It's in the Medicare guidelines. At admission and at subsequent visits code status should be discussed and the pt should be made a DNR if at all possible. The key is education and the gentle reinforcement of the hospice philosophy. Sometimes people panic and call 911 even if the pt is a DNR. If the pt gets admitted for something that is related to their diagnosis then the family must revoke services or they will be responsible for the charges incurred at the hospital. To answer your question all hospice companies run into this. The company for whom I work will occasionally pay for PALLIATIVE radiation for comfort, or 1-3 PT visits for safe transfers. Other than that most things are out of the hospice guidelines. CT scans, PET scans etc. the bottom line is that if the pt/family want heroic measures and diagnostics then they must revoke. They just aren't ready. Education and exploring the pt/families sometimes changing needs is critical! Hope this helps!

Allison. BS RN CHPN CM

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